It’s always scary when your child is ill and requires hospital treatment or admission. This is compounded when you have another one or even two babies who also need you. Bliss (the charity that supports families or premature babies) states that ‘parents are not visitors’ to their child in hospital. Similarly, a breastfed twin or triplet should not be considered a visitor when their sibling is hospitalised.

Hospital policies (if they even exist) are tailored to singletons and refer to siblings of a different age. A breastfed twin or triplet is so much more than ‘just’ a sibling. The Hospital Infant Feeding Network states that one of their priority aims is to ‘educate health professionals on….protecting supply and infant feeding skills where [any] member of the dyad is unwell’. The Hospital Infant Feeding Network’s open letter calls for all hospitals caring for families to ‘keep mothers and children together as much as possible, acknowledging that neither is a visitor’ and to ‘value and prioritise the breastfeeding relationship when a breastfeeding mother or child are hospitalised’.

Hospitals, particularly within the UNICEF Baby Friendly Initiative accreditation scheme, have become better at considering, valuing and promoting the breastfeeding pair of parent and child. The breastfeeding group of parent and multiple babies is often not considered, or is somehow thought to be different. Anything that affects one member of the group affects them all. All multiple babies need the same valuing and the same access to their breastfeeding parent as any singleton baby. They are no less important or breastfeeding dependent by virtue of being one of twins or triplets. UNICEF’s report ‘From the First Hour of Life’ makes clear that ‘building breastfeeding friendly policies, health systems, workplaces and communities is everyone’s responsibility’.

The risks of separating the breastfeeding group;

• Blocked ducts and mastitis in the breastfeeding parent

• A bottle refusing baby left at home becoming ill and dehydrated (the other twin or triplets may well be ill too) maintaining their hydration and comfort, which may also prevent the need for their future admission.

• The baby(ies) at home who have to have bottles may refuse the breast afterwards, and this may prematurely end or limit their breastfeeding journey. This has potential life long health implications and mental health implications for the breastfeeding parent who does not achieve their breastfeeding goals and has to live with the consequence of choosing between their babies.

• The antibodies within the breastmilk will be keeping the other baby(ies) as well as possible. Limiting their intake or access may mean they may be more likely to succumb to the same illness.

• Not everyone responds well to a pump. It’s not as easy as ‘just pump and they can have it in a bottle’

• A stressed parent separated from one or more dependent babies is not the best support for the ill child.

• The caregivers for the separated baby(ies) may have no other option but to use formula. The risks of using formula for the baby(ies) denied access to their breastfeeding parent must be assessed and discussed.

Escalation;

• Speak to the nurse looking after you.

• Speak to the nurse in charge of the ward.

• Speak to the Hospital Infant Feeding Lead if they are on shift.

• Speak to the Hospital Manager. There will always be a bleep holder who is on shift manager 24 hours a day- Contact PALS (PASS in Scotland, PCC in Northern Ireland, PAS in the Republic of Ireland).

Covid19 Specific Information;

• Everyone in the family home has already been exposed if it is a possible postive Covid infection

• Continuing to breastfeed keeps all babies as well as possible and is safe and desirable to continue to do (link to Breastfeeding Network Coronavirus Update)

• Breastfeeding parent will go home with no quarantine period

• Home parent is likely to be visiting so is going between hospital and home, so any infection (including Covid) encountered in hospital will be transmitted home

• Suggestions of ‘protecting’ the other twin or triplets by banning them are erroneous and ill thought out.

Advocate as strongly, but calmly as you feel able to, for your children and breastfeeding relationship. This is likely to be the first time most health care professionals have encountered this situation. Their initial reactions can be based on ignorance, lack of thought, and adherence to policies that contain blind spots. Ask them to take the time to listen to you and your reasons, and to value all of your choices.

Hoping that you and all of your breastfed children are better and home soon.

Sarah Mason, peer supporter, Dec 2021